I teach about business to Chinese medicine students at NUNM. As is typical, I’m learning more from them than they likely learn from me. One of the things that continually inspires me about these students is the way they feel utterly free from the trappings and expectations of the received wisdom in the business world.
This may be because I teach exceptionally unburdened students.
It may also be because the nature of our profession is such that prescribed notions of how to practice are not yet set in stone. It may have something to do with the shifting, changing nature of business itself, particularly over the last 10 years. I believe, though, that a lot of it has to do with the nature of the way Chinese medicine is taught – at least at NUNM – and the way it transforms the students that take it seriously.
For me, learning Chinese medicine was about personal growth just as much as it was about acquiring medical information.
I grew a ton as a student, of course, but what I learned more was a framework to help guide me on a path of lifelong self understanding and development. Now, don’t get me wrong, I learned some pretty incredible information about how to practice medicine – the acupuncture, the herbs, and beyond. But, to be honest, most of the information of that type that I use now I got outside of the curricular confines. What I got from the school curriculum, however, was maybe even more important – and lately it has really taken hold of me.
I find myself in a lineage of Chinese herbal medicine that, in many ways, is quite strict. The formulas I prescribe come only from three places: the received texts of Zhang Zhongjing, the fragmented text known popularly as the Tangye jing and a few unrecorded formulas that were passed down only through oral tradition. The way I learned the medicine doesn’t leave a lot of room for flights of fancy – and it works remarkably well.
But, what I didn’t learn from my most cherished texts and teachers is how to work with contemporary patients.
Sure, I saw how my teachers worked in clinic, and learned a thing or two from them. But, when it comes to the patients that walk through my door, the problems they face, and what they need from me – I’ve been operating in the shadows. I’m fortunate to be connected to peers who are open with their own experiences, and that has been a wealth of information. Still, there’s a lot left that’s not covered in any book, in the words of my teachers, or in the shared experiences of my colleagues. There’s a lot that’s up to me.
A quick note – I’m not saying that the classical texts or the treatments that come from them cannot be used with contemporary patients as-is. Far from it. It’s just that because of the historical and in some cases environmental change that has happened since the Han dynasty, things may be presenting differently, or may need a slightly different treatment focus in order to be perfectly aligned for our times.
This reminds me of one of the things that we heard most while in school.
We were told by many teachers that we need to “make the medicine our own.” This can be interpreted in a number of ways, of course. Unfortunately, too many decide that it means they don’t have to pay much attention to the way they were taught and instead just practice the easiest way, or the way that satisfies their random impulses. I always took it to mean that I needed to take the information into my mind and learn it well enough that the answers to vexing clinical questions come from within.
I do think that’s part of what my teachers meant – but I’m starting to understand another layer of meaning as well.
I think this principle should apply not just to what happens in the treatment room, but also to the business practices I engage in. From where I decide to practice, to the arrangement of space in my clinic, to the types of patients I reach out to and – especially – the practical ways I work with them. I’m starting to see that my patients benefit most when I bring all of my skills and experience to bear on their cases. I’m starting to understand that what is necessary is that I step out of the stale clinical model I’ve inherited and, instead, work with patients in a new way.
There are standard models of practice that most of us engage in. Some people practice alone, in a larger building or something free-standing, some even in a room of their own homes. The practice is home-cooked, small, without many bells and whistles – cozy, personal. Other people choose to join with others as they practice, possibly in a larger building, often with multiple modalities represented (massage, Naturopathic medicine, and so on). Both of these models, and their variations, are similar to the way that biomedical professionals operate, particularly in general or family practice.
Patients come to these practices in diverse ways, sometimes because of marketing efforts but most often because of insurance or friend/family referrals. They are scheduled, they fill out paperwork, they have their initial intake – often with a treatment included. They will then enter into the flow, coming back at regular intervals, taking Chinese herbal formulas and, perhaps, supplements, and progressing at whatever speed.
Some practitioners add other elements, perhaps employing qigong or taiji instruction into their practice, or Chinese astrology, or various forms of bodywork. Some will teach classes for patients and the general public to inform the patients about Chinese medicine or other topics. This is, more or less, the model I’ve been using since I entered practice.
Patients have found benefit, to be sure.
There are some alternatives to this model of practice. Of course there are larger institutions, like hospitals, where some Chinese medicine practitioners are starting to find success. Beyond that, the two alternatives with the greatest energy today are Group acupuncture and Mobile acupuncture.
In a general way, both seek to reach a wider variety and higher numbers of patients. Treatments are typically shorter and focused on acupuncture (as opposed to herbs, dietary therapy and any supplements) though this is not always the case. Treatment tends to be more frequent, and depth of case review and management a little shallower. Certainly some patients benefit from this style of Chinese medicine practice.
I’ve come to know myself very well in the last 36 years of living with me, and I know that these alternatives are not for me.
I’m not a volume guy, being fairly introverted with a high need for deep recovery between patients. It’s also true that as soon as I get to know the details of the case, my mind starts probing deeply, making far reaching connections, asking questions, building hypotheses. I need to research, and I need to do it quite a bit. I need to sit with the case, roll it over in my heart and spirit.
As I do this, I begin to see how the problem developed for the person, as well as the long road to recovery. This road involves not just acupuncture, but a series of herbal formulas, sometimes supplementation, lots of personal accountability and action, as well as sometimes difficult life choices. Further, I frequently see ways that education would help the person avoid future similar situations. Sometimes that education is in the realm of Chinese medicine, but sometimes it is about their bioregion, or their cultural context, and so on. As I’ve created treatment plans for patients, they’ve been excited and we’ve begun to travel together.
Unfortunately, because I have been working with the “received model” I haven’t created the tools, nor the space, to do this in a systematic way – guiding and teaching, tracking and adjusting, informing and supporting. Mostly, I’ve still managed to nurture positive patient outcomes. But, to be frank, it’s been unsatisfying. I yearn to teach, to be clearer and more systematic in my guidance. I want to be part coach, part practitioner, part teacher, part inspirer. That’s when I’m at my best.
When I’ve managed to do that, the results have been wonderful – for me and for the patient.
So, I’m creating a new model for my own practice that does all of this. It’s not a model I learned from my teachers, nor took from the classics, nor picked up in the curriculum at NUNM. What’s interesting is that I don’t feel like I’m “inventing” this, but it almost feels like something that is growing from the soil of my life. It is both the result and the process of “making this medicine my own.”
How have you made this medicine your own? Share your thoughts in the comments below!
[This post has been updated during the 2020 site updates. My goal during post updates was to keep the character of the original post, but update for corrections and clarity, as well as to remove broken links.]